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Plantar Plate Tears

The plantar plate is a part of the metatarsophalangeal joint's joint capsule. These often start off as capsulitis, but progress to the point that deformity can occur. 

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A person massages the bottom of their foot with both hands.

About the Plantar Plate

Every joint in the body is held together by a collection of ligaments, and these ligaments form a 'joint capsule'. 

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The plantar plate is one part of the joint capsule and it is responsible for preventing the 'upward translation' of the toe during the later stages of the 'push-off' cycle in gait.

 

When the plantar plate fails, this means that the toe gets pushed out of the way, and the head of the metatarsal is pushed more firmly into the ground. 

 

It also means that the flexor tendons that push the toes into the ground are not able to function as effectively.  

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Symptoms of a Plantar Plate Tear

Symptoms of a Plantar Plate Tear are very similar to the symptoms of Capsulitis:

  • Pain at the bottom of the knuckle joint under foot

  • Swelling or bruising

  • Feeling like there is a pebble in your shoe

As the tear in the plantar plate grows, you may notice that your toe starts to:

  • 'hammer' (lift off the ground)

  • move sideways (Churchill Sign)

  • rub on the top of your shoe

When the plantar plate is abruptly injured, you may also:

  • Bruising under the foot

  • Swelling

  • Have an overwhelming urge to swear and/or blaspheme.

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A man's foot with a hammer deformity of the left 2nd toe. This deformity is common in patients with a plantar plate injury.
An anatomy graphic of the bottom of the foot, including the plantar plate and it's associated structures.

What else could it be?

Other conditions that might mimic a plantar plate injury are:

  • Morton's Neuroma

  • Stress Fractures

  • Capsulitis

  • Flexor tendinitis

  • Sesamoiditis

  • Spasticity of the extensor tendons

How is a Plantar Plate Tear diagnosed?

Plantar plate injuries, if without much deformity can be difficult to differentiate from capsulitis. â€‹

Imaging that can be used for plantar plate injuries:

  • Ultrasound scans (particularly dynamic)

  • MRI Scans (can be particularly helpful for highlighting inflammation and differentiating)

  • Fluoroscopy

  • X-rays can be used to rule out other issues, like fractures

    • X-rays can also give 'clues' about whether the foot's structure has/had a role in the development of the injury.

A sagittal plane MRI view which might be used to demonstrate the integrity of the plantar plate.
A barefoot person standing lifting their big toes skywards, which is one exercise that might be given for patients with foot pain.

How are Plantar Plate Injuries treated?

Plantar plate injuries can be difficult to manage and require very careful and aggressive management early on. 

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Some of the treatments that are recommended include:

  • Stretching the calf muscles

  • Stiff-soled footwear

  • Aircast or CAM boots

  • Use of anti-inflammatories

  • Orthotics and insoles

  • Manipulation and mobilisation of joints

  • Shockwave therapy

  • Taping

  • Steroid injections (highly controversial)

Ready to start being pain free?

How long does it take to cure a Plantar Plate Tear?

If caught early, then a plantar plate tear can be managed very effectively, however, due to their location and the amount of force that gets put through the area, patients with a plantar plate injury should allow 6 months. 

If they are very careful, then 6-12 weeks is a reasonable time frame (injury dependent), but to manage expectations, 6 months is what I tend to quote. 

This being said, once the issue is identified and treatment is started, the more severe symptoms should resolve within 4 weeks. 

Lady running with her dog
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

If your symptoms fit the above, you will need to book a 'Foot Pain' consultation. This will be £95 and lasts approximately 60 minutes usually. If you need insoles, we'll give you some basic ones to try out (or some fancier ones and reduce their price!). 

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey, Podiatrist

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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